Provider Demographics
NPI:1912976044
Name:BILIS, MARIANNA (OD)
Entity Type:Individual
Prefix:
First Name:MARIANNA
Middle Name:
Last Name:BILIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3917 CHARLIE CT
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60026
Mailing Address - Country:US
Mailing Address - Phone:773-792-1011
Mailing Address - Fax:773-889-0224
Practice Address - Street 1:3500 W PETERSON AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-3306
Practice Address - Country:US
Practice Address - Phone:773-588-3090
Practice Address - Fax:773-588-3210
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046008924152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL046008924Medicaid
ILP00210269OtherRAILROAD MEDICARE
IL7060006Medicare PIN
ILP00210269OtherRAILROAD MEDICARE
IL7061006Medicare PIN
V04877Medicare UPIN
IL046008924Medicaid
IL7058006Medicare PIN
IL046008924Medicaid
IL046008924Medicaid